uptake of the seasonal influenza vaccine in acute ... · uptake of the seasonal influenza vaccine...

Uptake of the Seasonal Influenza Vaccine in Acute Hospitals and Long Term Care Facilities in Irelandin 2018-2019 v2.2, 13/09/2019

1

June 2019

Report prepared by:Piaras O’Lorcain, Suzanne Cotter, Kevin Kelleher

_____________________________________________________________________________________________________

HSE Health Protection Surveillance Centre. Uptake of the Seasonal Influenza Vaccine inAcute Hospitals and Long Term/Residential Care Facilities in Ireland in 2018-2019. Dublin:HSE HPSC; 2019

© HSE Health Protection Surveillance Centre, 2019. Reproduction is authorised, providedsource is acknowledged

Uptake of the Seasonal Influenza Vaccine in Acute Hospitals and LongTerm/Residential Care Facilities in Ireland in 2018-2019

A Report by the Health Protection Surveillance Centre


2

ContentsReport prepared by: .............................................................................................................................1

Summary and key points.....................................................................................................................3

Background ...........................................................................................................................................8

Methodology..........................................................................................................................................8

Results .................................................................................................................................................10

Section 1. HCW-based Hospital Survey .....................................................................................10

Hospital participation .................................................................................................................10

HCW vaccine uptake in public hospitals.................................................................................11

Vaccinated Hospital-based Staff Not On Payroll...................................................................13

Section 2. HCW-based LTCF survey ..........................................................................................14

LTCF participation ......................................................................................................................14

Public LTCFs - HCW vaccine uptake......................................................................................15

Section 3. Uptake among residents in LTCFs-Point Prevalence Surveys ............................19

LTCF participation ......................................................................................................................19

Respite Resident Vaccination Policies....................................................................................19

Discussion ...........................................................................................................................................21

Changes from previous annual reports...................................................................................21

Comparison with influenza vaccine uptake in other countries ............................................24

Acknowledgements ............................................................................................................................25

References ..........................................................................................................................................26


3

Summary and key pointsThis report relates to influenza vaccination uptake among health care workers (HCWs) andresidents in long term/residential care facilities (LTCFs) for the 2018-2019 influenza season.Uptake in HCWs in hospitals 59 hospitals (including eight private) and 269 LTCFs (including219 HSE funded and staffed) is presented.

Uptake among residents (permanent and those admitted for respite care) in LTCFs wasestimated by staff carrying out a point prevalence survey during the last week of January2019.

In this report HSE funded and staffed hospitals and LTCFs are referred to as ‘HSE’ or‘Public’ hospitals and LTCFs. Also, ‘uptake’ has been calculated as the numerator(overall number of vaccinated individuals) divided by the corresponding denominator(overall number of eligible individuals) and expressed as a percentage.

Appendices to this report are available as pdf documents or in a separate MS-excelfile on the HPSC website*. Please note: data provided in this report may differ fromprevious seasonal influenza vaccine uptake reports due to updating of previouslysubmitted data.

Key findingsInfluenza Vaccine Uptake in Public Hospitals, 2018-2019 (Table A, Figure A)

All 51 public hospitals participated in the 2018-2019 survey Based on 51 complete returns

o Uptake among all hospital HCWs was 53.2%o Six (11.8%) hospitals exceeded the 2018-2019 65% national uptake targeto Uptake varied by HSE Hospital Group (range 39.2-68.2%); the highest uptake

reported in ‘Dublin North East (RCSI)’o Uptake varied by HSE staff category (43.3-71.6%), the highest uptake was

reported among ‘medical and dental’ professionals and lowest among‘general support’ staff

Influenza Vaccine Uptake in Public LTCFs, 2018-2019 (Table B, Figure B)• 219 public LTCFs were identified as having participated in the current survey• Based on 219 complete returns

o Uptake among LTCF-based HCWs was 42.2%o 27 (12.3%) LTCFs exceeded the 65% national uptake targeto Uptake varied by Community Health Organisation (CHO) (range 30.2-52.9%)

with the highest uptake reported in CHO9o Uptake varied by HSE staff category (37.9-56.8%); the highest value was

reported among ‘health and social care’ professionals and lowest among‘general support’ staff

Uptake among residents in Public LTCFsDate of survey: last week of January 2019 (Table C)Among long-term residents

Uptake was 89.0% (range 84.2% [CHO4] – 96.6% [CHO7])Among respite residents

Uptake was 57.7% (range 12.5% [CHO6] – 91.3% [CHO3])

* http://www.hpsc.ie/a-z/respiratory/influenza/seasonalinfluenza/influenzaandhealthcareworkers/


4

Table A. Influenza vaccine uptake in Hospital-based HCWs by Hospital Group, StaffCategory Grade, Staff Size and Season (based on complete returns only)

Seasonal % Uptake in Hospital HCWs2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

2016-2017‡

2017-2018

2018-2019

Number of Participating PublicHospitals providing complete returns 36 32 41 39 46 48 49 51

Hospital GroupƗ

Children's Hospital Group§ 27.1 23.3 28.8 27.9 35.8 55.1 60.3 66.8Dublin Midlands (TCD) 18.1 21.5 25.0 31.0 34.0 40.7 43.6 57.7Dublin North East (RCSI) 25.6 29.0 37.2 28.6 31.2 43.2 58.8 68.2Ireland East (UCD) 19.8 18.3 29.6 24.8 26.3 36.7 45.9 55.4Midwest (UL) n/a n/a 13.4 17.9 17.5 25.2 41.5 41.6South/South West (UCC) 9.6 10.8 17.1 13.2 14.7 23.2 36.1 45.6West/North West (Saolta UHG; NUIG) 11.3 10.7 16.3 17.2 15.5 20.7 37.1 39.2Other* n/a n/a n/a 47.5 46.8 45.2 53.7 60.2HSE Grade CategoryGeneral Support Staff 22.1 22.5 26.7 25.1 25.8 30.4 38.3 43.3Health & Social Care Professionals 25.0 20.0 30.2 29.7 29.7 41.0 54.4 62.6Management & Administration 21.0 18.5 25.3 23.1 24.8 30.6 40.3 48.1Medical & Dental 21.9 23.5 33.4 36.6 41.0 54.7 66.4 71.6Nursing 12.4 12.6 18.4 17.2 18.9 27.5 39.8 50.4Other Patient & Client Care 19.7 21.7 24.2 24.7 23.3 31.3 35.9 44.3Eligible Staff Category Size<250 15.0 6.7 8.1 8.9 12.7 23.1 40.1 42.4250-499 28.9 21.2 19.8 22.5 24.3 32.2 46.5 49.4500-999 19.3 14.2 22.1 24.4 24.8 34.3 46.1 52.21000-1999 14.4 14.0 21.1 18.3 23.1 31.3 44.4 49.0≥2000 19.0 20.2 27.1 26.5 26.7 35.6 44.7 54.6Uptake (%) 18.1 17.6 24.1 23.5 25.2 34.0 44.8 53.2

Number of Participating Private Hospitalsproviding complete returns 1 0 5 3 4 5 7 8

Uptake (%) Private Hospitals Only 22.0 n/a 29.4 27.7 21.0 29.8 37.4 41.7

Uptake (%) All Hospitals 18.1 17.6 24.4 23.6 25.1 33.8 44.4 52.3n/a = not available/data not reported*Other=non-acute publicly funded hospitals i.e. National Rehabilitation Hospital, Dun LaoghaireƗSee http://www.hse.ie/eng/services/list/3/acutehospitals/hospitalgroups.html for details of hospital groups and their location‡Data for 2016-2017 changed from previous published annual report as the uptake for the Mater Misericordiae UniversityHospital was changed from 32.9% to 38.9% in October 2017§Renamed as Children’s Hospital Group from Acute Paediatric Group and includes three hospitals: Children's UniversityHospital, Temple Street, Our Lady's Hospital for Sick Children, Crumlin, and, new in 2018-2019, Children's Hospital Ireland(Tallaght University Hospital (paediatric) Unit)


5

Table B. Influenza vaccine uptake in LTCF-based HCWs by CHO, Staff CategoryGrade, Staff Size and Season (based on complete returns only)

*LTCFs who are private or whose funding status was not verified at time of writing**Includes two private LTCFs who reported no eligible or vaccinated staff

† Area 1: Donegal; Sligo/Leitrim/West Cavan; Cavan/Monaghan; Area 2: Galway; Roscommon; Mayo; Area 3:Clare; Limerick; North Tipperary/East Limerick; Area 4: Kerry; North Cork; North Lee; South Lee; West Cork;Area 5: South Tipperary; Carlow/Kilkenny; Waterford; Wexford; Area 6: Wicklow; Dun Laoghaire; Dublin SouthEast; Area 7: Kildare/West Wicklow; Dublin West; Dublin South City; Dublin South West; Area 8: Laois/Offaly;Longford/Westmeath; Louth/Meath; Area 9: Dublin North; Dublin North Central; Dublin North West

Seasonal % Uptake in LTCF HCWs2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

2016-2017

2017-2018

2018-2019

Number of Participating Public LTCFsproviding complete returns 57 108 88 67 81 102 130 219

Community Health Organisation (CHO) Area†

Area 1 16.7 11.0 23.8 27.4 21.0 24.7 26.0 30.2Area 2 11.2 10.3 14.5 23.2 17.8 19.9 37.6 44.6Area 3 14.0 14.1 26.2 52.7 30.6 41.7 35.3 47.1Area 4 5.8 12.5 11.4 22.2 22.7 24.0 43.6 46.7Area 5 21.0 7.3 15.7 14.3 15.6 22.2 28.7 43.0Area 6 27.3 22.1 32.1 29.9 22.1 30.3 34.2 48.5Area 7 23.6 15.1 17.3 28.5 25.1 29.7 37.2 41.0Area 8 17.5 20.7 23.4 24.5 22.1 31.7 32.4 41.4Area 9 24.8 23.2 31.2 38.3 35.9 28.8 51.0 52.9HSE Grade CategoryGeneral Support Staff 15.0 14.5 21.6 20.2 24.0 27.4 30.6 37.9Health & Social Care Professionals 19.8 8.6 25.7 23.4 22.0 36.0 39.4 56.8Management & Administration 21.3 16.4 11.5 27.0 24.3 31.4 39.5 49.8Medical & Dental 11.8 12.7 31.7 38.4 43.5 21.4 38.7 56.5Nursing 16.4 13.2 20.3 26.4 21.9 26.7 31.2 41.6Other Patient & Client Care 20.0 11.4 20.8 24.1 21.7 22.8 33.0 40.2Eligible Staff Category Size<50 13.4 15.3 20.5 26.7 25.1 30.8 38.7 41.950-99 21.3 16.0 21.7 26.2 23.5 26.9 36.3 43.1100-149 27.9 17.1 25.7 38.4 19.6 25.5 38.4 40.8≥150 9.7 9.3 15.2 20.1 23.1 26.9 29.6 42.5Uptake (%) 17.6 12.3 19.5 24.3 23.0 27.1 33.1 42.2

Number of Participating Private LTCFs*providing complete returns * 13 29 29 24 17 20 58 50**

Uptake (%) Private LTCFs Only* 21.3 20.8 29.9 28.8 34.6 29.2 32.8 35.8

Uptake (%) All LTCFs 18.0 14.4 23.3 25.7 25.9 27.8 33.1 40.0


6

0

2

4

6

8

10

12

14

16

<510

-14.

920

-24.

930

-34.

940

-44.

950

-54.

960

+5-

9.9

15-1

9.9

25-2

9.9

35-3

9.9

45-4

9.9

55-5

9.9 <5

10-1

4.9

20-2

4.9

30-3

4.9

40-4

4.9

50-5

4.9

60+

5-9.

915

-19.

925

-29.

935

-39.

945

-49.

955

-59.

9 <510

-14.

920

-24.

930

-34.

940

-44.

950

-54.

960

+5-

9.9

15-1

9.9

25-2

9.9

35-3

9.9

45-4

9.9

55-5

9.9 <5

10-1

4.9

20-2

4.9

30-3

4.9

40-4

4.9

50-5

4.9

60+

5-9.

915

-19.

925

-29.

935

-39.

945

-49.

955

-59.

9

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

Freq

uenc

y-No

. of P

ublic

Hos

pita

ls

Season & Percenatge Uptake Category

Figure A. Number of public hospitals by percentage uptake category and season,2012-2012 to 2018-2019, Ireland

0

5

10

15

20

25

30

35

<5

15-1

9.9

30-3

4.9

45-4

9.9

60-7

4.9

5-9.

9

20-2

4.9

35-3

9.9

50-5

4.9

75+

10-1

4.9

25-2

9.9

40-4

4.9

55-5

9.9 <5

15-1

9.9

30-3

4.9

45-4

9.9

60-7

4.9

5-9.

9

20-2

4.9

35-3

9.9

50-5

4.9

75+

10-1

4.9

25-2

9.9

40-4

4.9

55-5

9.9 <5

15-1

9.9

30-3

4.9

45-4

9.9

60-7

4.9

5-9.

9

20-2

4.9

35-3

9.9

50-5

4.9

75+

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

Freq

uenc

y-No

. of P

ublic

LTCF

s

Season & Percenatge Uptake Category

Figure B. Number of public LTCFs by percentage uptake category and season, 2012-2012 to 2018-2019, Ireland


7

Table C. Percentage uptake of influenza vaccine in point prevalence surveys amongresidents of LTCFs by CHO, 2017-2018 (n=2), 2018-2019 (n=1) (based on completereturns only)

Point Prevalence Survey #1- Point Prevalence Survey #2- Point Prevalence Survey #3-Last Week November 2017 approx. Last Week April 2018 approx. Last Week January 2019 approx.

Long-termresidents

Respite Long-term residents Respite Long-termresidents

Respiteresidents residents residents

CommunityHealthOrganisation(CHO)Area‡

Overall%

UptakeNo. of

LTCFs*Overall

%Uptake

No. ofLTCFs*

Overall %Uptake

No. ofLTCFs*

Overall%

UptakeNo. of

LTCFs*Overall %

UptakeNo. of

LTCFs*Overall

%Uptake

No. ofLTCFs*

Area 1 87.8 45 63.3 20 89.1 23 71.7 13 87.3 65 54.0 39Area 2 92.2 2 100.0 2 95.8 3 53.8 3 85.0 12 51.5 9Area 3 78.3 4 38.9 3 95.5 7 51.8 6 94.2 5 91.3 5Area 4 90.7 9 40.3 6 94.7 16 23.9 8 84.2 21 51.1 11Area 5 89.0 5 61.3 4 51.2 7 56.7 4 92.4 19 55.8 8Area 6 94.1 1 - 0 90.6 3 35.7 3 92.9 4 12.5 2Area 7 96.7 2 95.5 2 97.8 4 88.9 4 96.6 3 84.2 3Area 8 87.3 4 59.1 1 88.3 6 100.0 2 91.0 14 61.1 6Area 9 92.1 6 55.4 6 98.9 6 56.1 4 92.5 9 81.0 5All PubliconlyLTCFs

89.4 78 57.5 44 87.7 75 56.0 47 89.0 152 57.7 88

All LTCFs,includingprivate

89.2 123 58.7 64 88.5 107 48.0 63 89.3 182 53.1 95

*Even though a survey was completed by each LTCF, not all had respite residents, hence the different number of 'reporting'LTCFs for both long-term and respite residents in each point prevalence survey

‡Area 1: Donegal; Sligo/Leitrim/West Cavan; Cavan/Monaghan; Area 2: Galway; Roscommon; Mayo; Area 3:Clare; Limerick; North Tipperary/East Limerick; Area 4: Kerry; North Cork; North Lee; South Lee; West Cork;Area 5: South Tipperary; Carlow/Kilkenny; Waterford; Wexford; Area 6: Wicklow; Dun Laoghaire; Dublin SouthEast; Area 7: Kildare/West Wicklow; Dublin West; Dublin South City; Dublin South West; Area 8: Laois/Offaly;Longford/Westmeath; Louth/Meath; Area 9: Dublin North; Dublin North Central; Dublin North West


8

BackgroundHPSC has been reporting on uptake among health-care workers (HCWs) since the 2011-

2012 season. This eighth annual report summarises the uptake of seasonal influenza

vaccine in 2018-2019 amongst HCWs in acute hospitals and long term/residential care

facilities (LTCFs) (LTCFs include disability/mental health facilities and care for the elderly

units and cater for residents either for long term or short term durations).

Since 2008 the National Immunisation Advisory Committee (Immunisation Guidelines for

Ireland) has recommended annual influenza vaccination for HCWs, both for their own

protection and for the protection of their patients [1].

Achieving a high uptake of influenza vaccination among HCWs is recognised as a vital

infection control measure and an occupational health issue, to reduce the risk of influenza

transmission between patients and HCWs with the potential for severe disease for both

patients and staff.

Since 2013, the HSE has strongly supported the implementation of national and local action

plans to improve influenza vaccination coverage of HCWs in Ireland. At that time an uptake

target of 40% uptake was recommended. For the 2018-2019 season, this uptake target was

increased to 65%.

MethodologyA standard protocol is circulated those involved in influenza vaccine data collection in

hospitals or LTCFs (including influenza coordinators, senior managers, HSE area managers

each influenza season). The current protocol is available on the HPSC website§.

HCW uptake data collectionSeparate online survey forms for HCWs in hospitals and LTCFs (Appendices 1.1 and 1.2)

were designed using the http://www.demographix.com website. Links to these survey tools

are sent to each healthcare facility twice during the influenza season (November 2017 &

March 2019). The survey forms capture aggregate data on the number of HCWs (one of six

categories used by HSE: management and administration; medical and dental; nursing;

health and social care professional; other patient and client care; general support staff)

eligible for vaccination and the number vaccinated during the season. Each healthcare

facility was provided with instructions on how to complete the forms and included definitions

for the number eligible and vaccinated and a description of staff categories. Information was

§ http://www.hpsc.ie/a-z/respiratory/influenza/seasonalinfluenza/influenzaandhealthcareworkers


9

also requested on numbers of non-payroll staff vaccinated for the hospital-based surveys.

Non-responders were sent further reminders to respond.

For the end-of-season analyses, aggregate HCW-based data relating to vaccination uptake

between the start of October 2018 and early March 2019 were used for both hospitals and

LTCFs.

Statistical analyses were performed in MS-Excel and using the online tests at

www.socscistatistics.com. The significance level was fixed at 0.05.

Point prevalence surveys to estimate uptake in residentsOne point prevalence survey on long-term and respite residents in LTCFs (Appendix 1.3) for

the 2018-2019 season was conducted during the last week of January 2019. Point

prevalence survey methodology was used to estimate uptake in this population (twice) for

the first time during the 2017-2018 season.


10

Results

Section 1. HCW-based Hospital Survey

Hospital participation

For the 2018-2019 season, a total of 64 acute hospitals (n=52 (81.3%) HSE funded

(public/voluntary) and n=12 (18.8%) private) were eligible for inclusion in the survey.**

In all, 59 (92.2%) hospitals participated and responded by providing complete staff vaccine

uptake data returns. Fifty-three hospitals provided both provisional and final returns (89.8%)

and six (10.2%) provided final figures only.

Of the participating 59 hospitals, 51 (86.4%) were HSE funded and eight (13.6%) were

privately funded.

An increase in participation of both public and private hospitals is evident since reporting

began with the 2011-2012 influenza season (Figure 1).

36 3241 39

46 48 49 51

10

53

45 7

8

0

10

20

30

40

50

60

70

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

Part

icipa

tion

by H

ospi

tals

Season

Public Private

Figure 1. Reporting by 64 eligible hospitals (including 51 public and 13 private) in2018-2019** by influenza season, 2011-2012 to 2018-2019

** Since 2017-2018, separate uptake returns were submitted by the maternity unit in Cork UniversityHospital and by the paediatric unit in Tallaght Hospital, resulting in an increase in the total number ofeligible public hospitals from 49 to 51; an additional private hospital, Mater Private Hospital Cork,increased the total number of eligible private hospitals from 12 to 13.


11

HCW vaccine uptake in public hospitals

In 2018-2019, influenza vaccine uptake for all HCW in the 51 hospitals was 53.2%, up from

44.8% in 2017-2018 (Table 1), an increase that was statistically significant. Six hospitals

(11.8%) exceeded the 65% national uptake target, compared to two (4.0%) in 2017-2018.

Details of staff uptake within each hospital over the past eight seasons are presented in

Appendices 2.1 and 2.2. Appendix 3 presents a count of the hospitals within each hospital

group that exceeded the 65% national uptake target.

Table 1. Details of seasonal influenza vaccine uptake among HCWs in public hospitalsby influenza season, Ireland*

Season

Total No.Eligible

HCWs

Total No.Vaccinated

HCWs % UptakeMedian %

UptakeRange %

Uptake

No.Participating

Hospitals2011-2012 45058.0 8157 18.1 16.6 5.0-40.0 362012-2013 41490.2 7293 17.6 12.2 3.9-38.8 322013-2014 47760.4 11517 24.1 18.1 2.6-45.9 412014-2015 49917.2 11723 23.5 20.1 1.1-47.5 392015-2016 57493.5 14474 25.2 19.8 6.9-47.0 462016-2017Ɨ 62324.4 21195 34.0 29.6 6.4-63.7 482017-2018 64554.0 28947 44.8 43.8 13.8-74.8 492018-2019 66857.0 35585 53.2 52.2 22.0-84.8 51*based on complete returns only; ƗData for 2016-2017 changed from previous published annual report as the uptake for theMater Misericordiae University Hospital was changed from 32.9% to 38.9% in October 2017

By HSE Hospital GroupUptake was highest in the Dublin North East (RCSI) group and lowest in the West/North

West (Saolta UHG; NUIG) group (Figure 2). Details of uptake across the different Hospital

Groups during 2018-2019 are shown in Appendix 4.

By HCW category of staffUptake varied by HSE staff category (43.3-71.6%), with the highest value reported among

‘medical and dental’ professionals and lowest among ‘general support’ staff. Between 2017-

2018 and 2018-2019 uptake increased among all HCWs: nursing staff (50.4%, +10.6%);

other patient and client care staff (44.3%, +8.4%); health and social care professionals

(62.6%, +8.2%); management and administration (48.1%, +7.8%); medical and dental

professionals (71.6%, +5.2%); and general support staff (43.3%, +5.0%) (Figure 3). All of the

changes in uptake levels between the different categories of staff were statistically significant

(P<0.05). Details of uptake among different hospital staff grades in 2018-2019 are presented

in Appendix 5.


12

27.1

18.1 25

.6

19.8

9.6 11

.3

22.0

23.3

21.5

29.0

18.3

10.8

10.7

28.8

25.0

37.2

29.6

13.4 17

.1

16.3

29.4

27.9 31

.0

28.6

24.8

17.9

13.2 17

.2

47.5

27.7

35.8

34.0

31.2

26.3

17.5

14.7

15.5

46.8

21.0

55.1

40.7 43

.2

36.7

25.2

23.2

20.7

45.2

29.8

60.7

43.5

55.4

46.1

41.5

34.6 38

.3

53.7

37.2

66.8

57.7

68.2

55.4

41.6 45

.6

39.2

60.2

41.7

0

10

20

30

40

50

60

70

80

Children'sHospital Group

DublinMidlands (TCD)

Dublin NorthEast (RCSI)

Ireland East(UCD)

Midwest (UL) South/SouthWest (UCC)

West/NorthWest (SaoltaUHG; NUIG)

Other Private

Over

all %

Staf

f Upt

ake

Hospital Group

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

Figure 2. Uptake among HCWs in public hospitals by influenza season and HospitalGroup, and, separately in private hospitals, Ireland (based on complete returns only)††

22.1 25

.0

21.0

21.9

12.4 19

.7

18.122

.5

20.0

18.5 23

.5

12.6 21

.7

17.626

.7 30.2

25.3 33

.4

18.4 24

.2

24.1

25.1 29

.7

23.1

36.6

17.2 24

.7

23.525.8 29

.7

24.8

41.0

18.9 23

.3

25.230

.4

41.0

30.6

54.7

27.5 31

.3 34.038

.3

54.4

40.3

66.4

39.8

35.9 44

.8

43.3

62.6

48.1

71.6

50.4

44.3 53

.2

01020304050607080

General SupportStaff

Health & SocialCare Professionals

Management &Admin

Medical & Dental Nursing Other Patient &Client Care

All Staff

Over

all %

Upt

ake

HSE Staff Category2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

Figure 3. Uptake among HCWs in public hospitals by HSE grade category andinfluenza season, Ireland (based on complete returns only)

When 2018-2019 hospital data were categorised in groups in terms of the overall staff

numbers, no association was observed between uptake and staff size (Spearman’s rho

statistic=0.6, P>0.05). However, across all categories of staff sizes, uptake increased

between seasons 2017-2018 and 2018-2019 (Figure 4).

†† Notes: 1) data for the Midwest (UL) and in 2011-2012 and 2012-2013 was not reported; 2) excludes returnsfrom 8 facilities that reported as hospitals in previous seasons, but have now been correctly recorded as longterm care facilities. See http://www.hse.ie/eng/services/list/3/acutehospitals/hospitalgroups.html for a descriptionof hospital groups and their location; 3) National Rehabilitation Hospital is neither a private hospital or a hospitalthat falls within the 7 HSE hospital groups and therefore has been categorised under ‘other’


13

15.0

28.9

19.3

14.4 19

.0

6.7

21.2

14.2

14.0 20

.2

8.1

19.8 22.1

21.1 27

.1

8.9

22.5 24.4

18.3 26

.5

12.7

24.3

24.8

23.1 26

.7

23.1

32.2 34.3

31.3 35

.640.1 46

.5

46.1

44.4

44.7

42.4 49

.4 52.2

49.0 54

.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

<250 HCWs 250-499 HCWs 500-999 HCWs 1000-1999 HCWs >=2000 HCWs

Over

all %

Upt

ake

Eligible Hospital HCW Staff Category Size

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

Figure 4. Uptake among HCWs in public hospitals by staff size group and influenzaseason, Ireland (based on complete returns only)

The percentage of participating hospitals reporting uptake of ≥65% in 2018-2019 was 11.8%

(n=6/51) (Figure 5), an increase compared to 2017-2018 when it was 4.1% (n=2/49).

2.8% 0.0%4.9%

10.3%15.2%

29.2%

67.3%

11.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

% P

ublic

Hos

pita

ls M

eetin

g Na

tiona

lUp

take

Tar

get

Season

% Hospitals Meeting National Uptake TargetNational Target % Uptake

Figure 5. Percentage of public hospitals meeting the national uptake target, byseason, Ireland (based on complete returns only) (for 2011-2012 to 2017-2018 the national targetwas 40%, but in 2018-2019, it was raised to 65%)

Vaccinated Hospital-based Staff Not On Payroll

The overall number of vaccinated healthcare staff (including students) reported by hospitals

that were not on the payroll was 4,522 (range 0 to 582) and 186 in private hospitals (range 0

to 74). Of the 51 participating public hospitals, 10 (19.6%) did not indicate if any of their non-

payroll staff were vaccinated. One of the eight participating private hospitals did not report

vaccinated non-payroll staff numbers.


14

Section 2. HCW-based LTCF survey

LTCF participation

Since the surveys began in 2011-2012 season, 420 LTCFs in total have been involved in at

least one of the eight annual influenza uptake surveys, 53 of which have since closed. For

the 2018-2019 season, 367 LTCFs were identified as active, including 85 newly identified

LTCFs; during the same season, another 33 LTCFs (out of a total 53 closures since 2011-

2012) were reported as closed. Of the 367 LTCFs active during 2018-2019, 250 (68.1%)

were public (Figure 6.1).

For the 2018-2019 season, 219 public LTCFs (87.6%) submitted completed returns: 145

(66.2%) provided both initial and final cumulative data, 48 (21.9%) provided final cumulative

returns only and six (2.7%) provided cumulative data for the first survey (up until 18th

December 2018). The number of participating public LTCFs was the highest ever recorded

since reporting began and the completeness of reporting among these units was 100%

(Figure 6.1). Participation by public LTCFs was highest in CHOs 1, 2, 4 and 5 and lowest in

CHOs 6 and 7 (Figure 6.2). Figure 6.3 presents LTCF participation by staff category size

with CHOs 1, 2, 4 and 5 again with the highest level of participation, especially with LTCFs

with a staff compliment of <50 HCWs.

57108 88 67 81 102

130

21945

36

129 2

150

0

13

29

2924 17

20

58

48

5

10

21 1

5

0

2

0

50

100

150

200

250

300

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

Part

icipa

tion

by LT

CFs

Season

HSE/Public -complete return HSE/Public -incomplete returnPrivate-complete return Private-incomplete return

Figure 6.1 Participation by LTCF type, level of reporting and influenza season (2011-2012 to 2018-2019 season), Ireland


15

01020304050607080

Area 1: DL;SO/LM;CN/MN

Area 2: G;RN; MO

Area 3: CE;L; TN/EL

Area 4: KY;NC; NSL;

WC

Area 5: TS;CW/KK;WD; WX

Area 6:WW; DS;

DSE

Area 7: KE;DW; DSC;

DSW

Area 8:S/OY;

LD/WH;LH/MH

Area 9: DN;DNC; DNW

No. P

artic

ipat

ing

Publ

ic LT

CFs

CHO

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

Figure 6.2 Participation by public LTCFs by influenza season and CHO and season(2011-2012 to 2017-2018), Ireland (based on complete returns only)

0

10

20

30

40

50

60

Area 1:DL;

SO/LM;CN/MN

Area 2: G;RN; MO

Area 3:CE; L;TN/EL

Area 4:KY; NC;

NSL; WC

Area 5:TS;

CW/KK;WD; WX

Area 6:WW; DS;

DSE

Area 7:KE; DW;

DSC; DSW

Area 8:S/OY;

LD/WH;LH/MH

Area 9:DN; DNC;

DNW

No. o

f Pub

lic LT

CFs

Community Health Organisation

<50 HCWs

50-99 HCWs

100-149 HCWs

150+ HCWs

Figure 6.3 Participation among HCWs in public LTCFs by category of staff size andCHO, 2018-2019 influenza season, Ireland (based on complete returns only)

Public LTCFs - HCW vaccine uptake

In 2018-2019, influenza vaccine uptake for all staff in 219 LTCFs was 42.2%, up from 33.1%

in the previous season. Further uptake details by season are presented in Table 2. Details of

staff uptake by individual LTCFs in 2018-2019 are shown in Appendix 6.1. Details of staff

uptake in all LTCFs over the past eight seasons are presented in Appendix 6.2. In 2018-

2019, LCTFs in CHO9 had the highest uptake (52.9%), the lowest was reported in CHO1

(30.2%) (Figure 7). Full details are presented in Appendix 7.


16

Table 2. Details of seasonal influenza vaccine uptake among HCWs in public LTCFsby influenza season, Ireland*

Season

Total No.Eligible

HCWs

Total No.Vaccinated

HCWs % UptakeMedian %

UptakeRange %

Uptake

No.Participating

LTCFs2011-2012 4159 733 17.6 10.3 0-90.4 572012-2013 10823.0 1327 12.3 11.1 0.0-76.0 1082013-2014 8967.4 1745 19.5 18.3 0.0-80.0 882014-2015 7280.0 1766 24.3 25.0 0.0-77.1 672015-2016 7057.6 1625 23.0 22.2 0.0-100 812016-2017 9916.2 2690 27.1 24.7 0.0-75.0 1022017-2018 13952.2 4622 33.1 34.6 0.0-93.3 1302018-2019 13493.6 5688 42.2 40.5 0.0-96.7 219*based on complete returns only

16.7

11.2 14

.0

5.8

21.0 27

.3

23.6

17.5 24

.8

11.0

10.3 14

.1

12.5

7.3

22.1

15.1 20

.7 23.2

23.8

14.5

26.2

11.4 15

.7

32.1

17.3 23

.4 31.2

27.4

23.2

52.7

22.2

14.3

29.9

28.5

24.5

38.3

21.0

17.8

30.6

22.7

15.6 22

.1 25.1

22.1

35.9

24.7

19.9

41.7

24.0

22.2 30

.3

29.7 31.7

28.8

26.0

37.6

35.3

43.6

28.7 34

.2 37.2

32.4

51.0

30.2

44.6 47

.1

46.7

43.0 48

.5

41.0

41.4

52.9

0

10

20

30

40

50

60

CHO 1: DL;SO/LM;CN/MN

CHO 2: G; RN;MO

CHO 3: CE; L;TN/EL

CHO 4: KY; NC;NSL; WC

CHO 5: TS;CW/KK; WD;

WX

CHO 6: WW;DS; DSE

CHO 7: KE;DW; DSC; DSW

CHO 8: S/OY;LD/WH;LH/MH

CHO 9: DN;DNC; DNW

Over

all %

Upt

ake

Community Health Organisation (CHO)

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

Figure 7. Uptake among HCWs in public LTCFs by influenza season and CHO,Ireland (based on complete returns only)See footnote at bottom of page 7 for details of each Community Health Organisation and their location

Uptake by staff gradeBetween 2017-2018 and 2018-2019 uptake increased across all staff grades: medical and

dental staff (56.5%, +17.7%); health & social care professionals (56.8%, +17.3%); nursing

(41.6%, +10.4%); management & administration (49.8%, +10.2%); general support staff

(37.9%, +7.3%) and other patient and client care professional (40.2%, +7.2%) (Figure 8).The

increases in uptake levels were statistically significant across all categories of staff between

2017-2018 and 2018-2019. Please see Appendix 8 for details of uptake by LTCF staff grade

in 2018-2019.


17

15.0 19

.8

21.3

11.8 16

.4 20.0

17.6

14.5

8.6

16.4

12.7

13.2

11.4

12.3

21.6 25

.7

11.5

31.7

20.3

20.8

19.5

20.2 23

.4 27.0

38.4

26.4

24.1

24.3

24.0

22.0 24

.3

43.5

21.9

21.7

23.027

.4

36.0

31.4

21.4 26

.7

22.8 27

.130.6

39.4

39.5

38.7

31.2 33.0

33.137

.9

56.8

49.8 56

.5

41.6

40.2 42.2

0

10

20

30

40

50

60

General SupportStaff

Health & SocialCare Professionals

Management &Admin

Medical & Dental Nursing Other Patient &Client Care

All Staff

Over

all %

Upt

ake

HSE Staff Category2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

Figure 8. Uptake among HCWs in HSE funded and staffed LTCFs by HSE gradecategory and influenza season, Ireland (based on complete returns only)

Uptake across all categories of staff sizes increased between seasons 2017-2018 and 2018-

2019. Larger staff numbers per facility were not associated with higher uptake (Spearman’s

rho statistic=-0.6, P>0.05) (Figure 9).

Overall, 12.3% (n=27/219) of the participating public LTCFs reported uptake of ≥65% in the

2018-2019 season, down slightly from 13.1% (n=17/130) in the previous season (Figure 10;

Appendix 9). Also, in 2018-2019, CHO9 reported the highest frequency of public LTCFs

(44.4%; n=4/9) with an uptake of ≥65% (Appendix 9).

13.4

21.3

27.9

9.7

15.3

16.0

17.1

9.3

20.5

21.7 25

.7

15.2

26.7

26.2

38.4

20.125

.1

23.5

19.6 23

.1

30.8

26.9

25.5 26.9

38.7

36.3 38

.4

29.6

41.9

43.1

40.8 42.5

0.05.0

10.015.020.025.030.035.040.045.050.0

<50 HCWs 50-99 HCWs 100-149 HCWs >=150 HCWs

Over

all %

Upt

ake

Eligible LTCF HCW Staff Category Size

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

Figure 9 Uptake among HCWs in public LTCFs by category of staff size and influenzaseason, Ireland (based on complete returns only)


18

10.5%4.6%

15.9%

26.9%

8.6%

23.5%

40.0%

12.3%

0%

10%

20%

30%

40%

50%

60%

70%

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2018-2019

% P

ublic

LTC

Fs M

eetin

g Na

tiona

lUo

take

Tar

get

Season

% LTCFs Meeting National Uptake TargetNational Target % Uptake

Figure 10. Percentage of public LTCFs meeting the national uptake target, by season,Ireland (based on complete returns only) (for 2011-2012 to 2017-2018 the national targetwas 40%, but in 2018-2019, it was raised to 65%)

Staff Vaccination Policy in LTCFs

With each season since 2012-2013, the cumulative‡‡ number of LTCFs with a staff

vaccination policy has increased, yet the total number in 2018-2019 represents just over a

fifth of all participating LTCFs (n=57/269=21.2%); for public LTCF only, this was slightly less

at 19.6% (n=43/219) (Figure 11, Appendix 10).

9 12 1422 25 32

43

1 2 46 7

12

14

7.312.0

19.8

28.626.2

23.421.2

0.0

5.0

10.0

15.0

20.0

25.0

30.0

0

10

20

30

40

50

60

2012-2013(n=137/205)

2012-2013 to2013-2014

(n=117/210)

2012-2013 to2014-2015(n=91/236)

2012-2013 to2015-2016(n=98/229)

2012-2013 to2016-2017

(n=122/270)

2012-2013 to2017-2018

(n=188/336)

2012-2013 to2018-2019

(n=269/367) % A

ll Pa

rtici

patin

g LT

CFs w

ith a

Sta

ffVa

ccin

atio

n Po

licy

Cum

ulat

ive

num

ber o

f LTC

Fs w

ith a

staf

f vac

cinat

ion

polic

y

Season

HSE Funded and staffed Other % of Participating LTCFs with a Staff Vaccination Policy

Figure 11. Cumulative number and percentage of participating LTCFs (public andprivate) that reported having a Staff vaccination policy from 2012-2013 to 2017-2018,Ireland§§

‡‡ The reason for presenting cumulative figures is because the question of a LTCF having a staff vaccinationpolicy is not always answered every year and here it has been assumed that once a policy has been put in placeit is maintained subsequently every season thereafter.§§During this period, two LTCFs have since closed, one public and the other which was not; staff vaccinationquestion not asked in 2011-2012 season; Includes details of the number of participating and known, eligibleLTCFs at the time of each survey


19

Section 3. Uptake among residents in LTCFs-Point Prevalence Surveys

LTCF participation

One point prevalence survey (PPS) of residents was conducted during 2018-2019, the last

week of January 2019. Participation involved 161 public LTCFs (191 including private ones).

Respite Resident Vaccination Policies

The cumulative*** number of public LTCFs that reported having a policy recommending that

respite residents are vaccinated before being admitted was 66 out of 219 LTCFs (30.1%) in

2018-2019, compared to 62 out of 130 (47.7%) LTCFs in the previous season (Figure 12,

Appendix 11).

5 1329 38 44

56 62 66

01

36

6

818 19

4.210.2

27.4

48.4 51.0 52.5

42.6

31.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

0102030405060708090

2011-2012(n=120/211)

2012-2013(n=137/205)

2012-2013 to2013-2014

(n=117/210)

2012-2013 to2014-2015(n=91/236)

2012-2013 to2015-2016(n=98/229)

2012-2013 to2016-2017

(n=122/270)

2012-2013 to2017-2018

(n=188/336)

2012-2013 to2018-2019

(n=269/367) % A

ll Pa

rtici

patin

gLTC

Fs w

ith a

Res

pite

Resid

ent V

accin

atio

n Po

licy

Cum

ulat

ive

num

ber o

f LTC

Fs w

ith a

Resp

ite R

esid

ent V

accin

atio

n Po

licy

Season

HSE funded and staffed Other % of Participating LTCFs with a Respite Resident Vaccination Policy

Figure 12. Cumulative number and percentage of participating LTCFs (public andprivate) that reported having a Respite Resident Vaccination Policy by influenzaseason from 2011-2012 to 2018-2019, Ireland

Uptake among long-term residents in 152 public LTCFs was 89.0% in January 2019

compared to the previous PPS in April 2018 when it was 87.7% among 75 public LTCFs

(Figure 13, Appendix 12). In January 2019, the lowest long term resident uptake was

recorded in CHO4 (84.2%) with the highest in CHO7 (96.6%).

Uptake among respite residents in public LTCFs was 57.7% in January 2019 (n=88 LTCFs),

slightly more than the 56.0% in April 2018 (n=47 LTCFs) (Figure 14, Appendix 12). In

January 2019, the lowest respite resident uptake was recorded in CHO6 (12.5%) with the

highest in CHO3 (91.3%).

*** The reason for presenting cumulative figures is because the question of a LTCF having a respite residentvaccination policy is not always answered every year and here it has been assumed that once a policy has beenput in place it is maintained subsequently every season thereafter.


20

0.0

20.0

40.0

60.0

80.0

100.0

Area 1:DL;

SO/LM;CN/MN

Area 2: G;RN; MO

Area 3:CE; L;TN/EL

Area 4:KY; NC;

NSL; WC

Area 5:TS;

CW/KK;WD; WX

Area 6:WW; DS;

DSE

Area 7:KE; DW;

DSC; DSW

Area 8:S/OY;

LD/WH;LH/MH

Area 9:DN; DNC;

DNW

All Publiconly LTCFs

All LTCFs,includingprivate

Over

all %

Upt

ake

Long

-term

Resid

ents

Community Health OrganisationPPS1-Nov 2017 PPS2-Apr 2018 PPS3-Jan 2019

Figure 13. Uptake among Long-term Residents in LTCFs in Point Prevalence Surveysin November 2017, April 2018 and January 2019, Ireland

0.0

20.0

40.0

60.0

80.0

100.0

Area 1:DL;

SO/LM;CN/MN

Area 2:G; RN;

MO

Area 3:CE; L;TN/EL

Area 4:KY; NC;

NSL; WC

Area 5:TS;

CW/KK;WD; WX

Area 6:WW; DS;

DSE

Area 7:KE; DW;

DSC;DSW

Area 8:S/OY;

LD/WH;LH/MH

Area 9:DN;

DNC;DNW

All Publiconly

LTCFs

AllLTCFs,

includingprivate

Over

all %

Upt

ake

Resp

iteRe

siden

ts

Community Health OrganisationPPS1-Nov 2017 PPS2-Apr 2018 PPS3-Jan 2019

Figure 14. Uptake among Respite Residents in LTCFs in Point Prevalence Surveys inNovember 2017, April 2018 and January 2019, Ireland


21

Discussion

Changes from previous annual reports

ParticipationWith respect to complete vaccine uptake returns for HCWs, all of the public hospitals (n=51)

participated in the current survey, additionally 61.5% (n=8/13) of private hospitals, who are

not obliged to participate, also submitted returns.

Participation among the public LTCFs improved substantially since the last HCW-based

survey, increasing from 65% (n=130/200) to 87.6% (n=219/250); in contrast, over the same

period of time, participation by private LTCFs decreased from 47.5% (n=5/122) to 42.7%

(n=50/117). Improvement in uptake was observed in the level of participation by public

LTCFs in CHOs 1, 2, 4 and 5. Much of this increase reflects participation by smaller

residential units, some of which stem from the local decentralisation of larger units; the

increased participation in CHOs 1, 2, 4 and 5 was not observed in CHOs 6 and 7.

There was a marked improvement in participation by LTCFs in the latest point prevalence

survey compared to the previous one held in April 2018. Participation by public LTCFs caring

for long term residents increased from 37.5% (n=75/200) to 60.8% (n=152/250) and, for

those public LTCFs looking after respite residents, participation increased from 23.5%

(n=47/200) to 35.2% (n=88/250).

UptakeBetween 2017-2018 and 2018-2019, the uptake among HCWs based in public hospitals

increased markedly from 44.8% to 53.2% (+8.4%). An increase was also observed in public

LTCFs over the same period, with HCW uptake rising from 33.1% to 42.2% (+9.0%).

In public hospitals, uptake in 2018-2019 was highest (66.8%) in the Children’s Hospital

group having increased from 60.3% in 2017-2018 (when the paediatric unit of Tallaght

Hospital was not part of this group at the time). LTCFs located in CHO9 reported the highest

uptake (52.9%), up from 51.0% since the previous season.

Between 2017-2018 and 2018-2019, the change in uptake in public hospitals was highest

among medical and dental staff (71.6%, up from 66.4%) and lowest in general support staff

(43.3%, up from 38.3%). In contrast, the change in uptake in public LTCFs was highest

among health and social care professionals (56.8%, up from 39.4%) and lowest among

general support staff (37.9%, up from 30.6%) during the same period. Despite considerable

improvements this season, further increases in overall HCW uptake would be possible if

vaccine uptake by nurses in public hospitals (50.4%) and LTCFs (41.6%) was targeted given


22

that this cohort of staff (based on these surveys) accounted for 39.7% (n=26530/66857) of

all HCWs in public hospitals and 37.7% (n=5082.8/13493.6) in public LTCFs in 2018-2019.

In public hospitals, uptake in 2018-2019 was highest where staff size number was ≥2000

HCWs (54.6%) and lowest where it was <250 (42.4%), a pattern that has been maintained

over the previous seasons (except for 2011-2012 and 2017-2018 when uptake was highest

in the 250-499 HCW category). No equivalent consistent pattern was observed with the

LTCFs.

In 2018-2019, the national uptake target was raised from 40% to 65%. Despite considerable

improvement since 2017-2018, the 65% uptake target among all HCWs in either public

hospitals or LTCFs was not reached. However, the number of individual public hospitals and

LTCFs that provided complete returns with uptakes of ≥65% increased in comparison to the

last season: from 4.1% (n=2/49) to 11.8% (n=6/51) in hospitals (+7.7%) and, from 13.1%

(n=17/130) to 12.3% (n=27/219) in LTCFs (-0.8%). The improvement seen in the hospitals is

part of a consistent trend since 2013-2014.

In January 2019, high uptake levels among long term residents in public LTCFs were

maintained (89.3%) and marginally exceeded that which was recorded in the point

prevalence survey in April 2018 (88.5%). In contrast, uptake among respite residents in

public LTCFs was considerably less in January 2019 (53.1%), but still higher than that

recorded in April 2018 (48.0%). Reasons for non-vaccination of those in respite were not

explored in the point prevalence survey, but are needed to inform communications and

policies relating to respite care. The most recent survey identified that there is an increase in

in resident vaccination policies by LTCFs and, if implemented by all LTCFs, would increase

uptake.

There are a multiple of reasons that are likely to have contributed to the significant increase

in uptake during the 2018-2019 season. These include endorsement from professional

bodies, such as the Irish Medical Council, the General Medical Council (UK), the Royal

College of Nursing (UK) and the Irish Society of Chartered Physiotherapists (ISCP) which

recommend vaccination against common serious communicable diseases [2]. This comes

on foot of recommendations set down by numerous international and respected public health

bodies, the World Health Organisation (WHO), the Centers for Disease Control and

Prevention (CDC) in the United States (US), the Healthcare Infection Control Practices

Advisory Committee (HICPAC) in the US, the Advisory Committee on Immunisation

Practices (ACIP), the European Centre for Disease Prevention & Control (ECDC), the Joint

Committee on Vaccination & Immunisation (JCVI) in the United Kingdom, the Australian

Technical Advisory Group on Immunisation (ATAGI), and the Canadian National Advisory


23

Committee on Immunisation (NACI) [2]. Furthermore, in October 2018, the Royal College of

Physicians in Ireland (RCPI) recommended a call for mandatory seasonal flu vaccination for

healthcare professionals in high risk clinical settings because it regards all those working in

direct contact with patients in hospitals and communities have a responsibility to protect

against infection [2]. The HSE does not currently recommend mandatory vaccination for

HCWs, however.

A media campaign to promote vaccination and the implementation of legislation to enable

pharmacists to immunise has also had a positive impact [2].

Another contributory factor may be the continuation of a specific HSE financial

incentivisation scheme first introduced in 2017-2018, which awards top performing and

improving hospitals and LTCFs.

While standard infection control precautions, such as hand hygiene and respiratory etiquette,

will reduce the risk of influenza spreading from infected HCW to patients, these precautions

are not full-proof or universally applied [3]. It is therefore clear that further efforts by way of a

multi-faceted approach are needed if the 75% target goal for influenza vaccination coverage

in all at-risk groups, including HCWs as recommended by the European Council in

December 2009 [4], is to be reached.

Issues and feedbackVery limited feedback in relation to the programme and data provision was provided by some

hospital data providers. The comments related to students and other non-payroll staff

vaccinated in the hospital setting. Even though it was not possible to verify that vaccinated

students had not been included in the final uptake returns, their separate reporting on the

online survey form should have minimised the chances of this occurring by mistake.

For LTCFs, most comments concerned the numbers of vaccinated, non-payroll/agency staff,

but there was also a one or two comments relating to staff vaccinated off-site, staff on leave,

the cumbersome process of retrieving data details and of the reluctance by some staff to

share their vaccination status details with management. The protocol for reporting on uptake

refers to employed staff, but in 2018-2019 three of the 269 participating LTCFs included

evidence suggestive of submitting WTE eligible staff numbers (i.e. values with decimal

points), rather than actual headcount numbers, in their returns.

Another issue that emerged concerned what is a long term care facility. One definition is that

a LTCF is a facility that provides rehabilitative, restorative, and/or ongoing skilled nursing

care to patients or residents in need of assistance with activities of daily living. Not all LTCFs

cater for long term care residents or respite residents, whilst others do so exclusively. In


24

other words, not all residential care facilities are genuinely long term care facilities (‘LTCFs’).

Judging from the increased level of participation this season, many catered for smaller

numbers of residents and even though they all had a residential remit, they catered for

residents who resided for days, rather than weeks, months or years. It is arguable that the

term ‘LTCF’ may have dissuaded some residential units from participating in annual surveys

heretofore. With that in mind, ‘LTCFs’ will refer more explicitly to ‘long term/residential care

facilities’ in future HPSC surveys.

Up to now, details of the type of residents cared for by the LTCF has not been captured

systematically in the annual HPSC surveys. Apart from the fact that the profile or mix of

residents can change over time, the availability of this information may further explain why

uptake in some LTCFs is different from others, in much the same way that uptake can be

different between public and privately-run entities.

Comparison with influenza vaccine uptake in other countries

Increased vaccine uptake by HCW has been shown to reduce morbidity and mortality in

aged care residents. Four landmark randomised controlled studies of the impact of HCW

vaccination on morbidity and mortality in these facilities have demonstrated substantial

decreases in all-cause mortality and influenza-like illness [5-8]. However, some have argued

that the magnitude of the effects reported in these studies is overstated [9]. One Cochrane

review concluded that these studies were at risk of bias, but supported the conclusion that

influenza vaccination of HCW in settings in which residents are also vaccinated provided

significant reductions in deaths among elderly patients from all causes and deaths from

pneumonia [10].

In England, vaccination uptake among those HCWs with direct patient contact is monitored

(compared to Ireland where uptake among all HCWs is monitored). During the 2018-2019

season, influenza vaccine uptake among frontline HCWs was 70.3%, an increase of 1.6%

from 68.7% for the previous season [11].

In the United States, an Internet panel survey of health care personnel was conducted for

the Centers for Disease Control during March 27–April 17, 2018 to provide estimates of

influenza vaccination coverage among health care personnel during the 2017–2018

influenza season: 78.4%, similar to the previous four seasons. Coverage in the 2017–2018

season was highest among health care personnel working in hospital settings (91.9%)

followed by those working in ambulatory care (75.1%), other clinical settings (74.9%), and

long-term care settings (67.4%). Overall, vaccination coverage in 2017–2018 was higher

among physicians (96.1%), pharmacists (92.2%), nurses (90.5%), and nurse practitioners

and physician assistants (87.8%), and lower among other clinical health care personnel


25

(80.9%), assistants and aides (71.1%), and nonclinical health care personnel (72.8%).

Vaccination coverage was highest (94.8%) among health care personnel working in settings

where vaccination was required. Overall, 44.1% of health care personnel reported a

requirement to be vaccinated; those working in hospitals were more likely to report a

vaccination requirement (68.3%) than were those working in ambulatory care (39.2%), long-

term care (29.6%), or other clinical settings (37.9%) [12].

In Ottawa, Canada, seasonal influenza immunisation coverage rates for staff of long term

care homes (LTCH) and public hospitals are reportable to the local Medical Officer of Health

and in 2018-2019, the median seasonal influenza immunisation coverage estimate was

52.6% for hospital staff and 72.8% for LTCH staff, comparable to uptake levels reported

during the previous three seasons [13].

In New Zealand the Ministry of Health introduced a goal of 80% of all HCW to be immunised

annually against influenza. HCW influenza coverage for 2018 in all district health boards

reported HCW influenza coverage of 68%, the highest coverage has been since 2010 [14].

AcknowledgementsHPSC wishes to thank all those who provided data for this report, especially the nominated

influenza coordinators and other contacts within the hospitals and long-term/residential care

facilities across the country, both public and private.


26

References1. National Immunisation Advisory Committee Immunisation Guidelines Chapter 11 –

Influenza. . Available athttps://www.hse.ie/eng/health/immunisation/hcpinfo/guidelines/chapter11.pdf

2. Influenza Vaccination of Healthcare Workers. Position paper of Royal College ofPhysicians in Ireland (RCPI). Published October 2018. Available at https://rcpi-live-cdn.s3.amazonaws.com/wp-content/uploads/2018/11/Influenza-paper-full-Oct-2018.pdf.

3. Evidence Review-Influenza vaccination and healthcare workers (HCW)-New SouthWales, Government, Australia. November 2018. Available at:https://www.health.nsw.gov.au/Infectious/Influenza/Publications/flu-vax-hcw-review.pdf

4. Commission of the European Communities. Proposal for a Council recommendationon seasonal influenza vaccination. Brussels; Commission of the EuropeanCommunities; 2009. Available athttp://ec.europa.eu/health/ph_threats/com/Influenza/docs/seasonflu_rec2009_en.pdf

5. Potter J, et al. Influenza vaccination of health care workers in long-term-carehospitals reduces the mortality of elderly patients. J Infect Dis. 1997; 175: 1–6.

6. Carman WF, et al. Effects of influenza vaccination of health-care workers on mortalityof elderly people in long-term care: a randomised controlled trial. Lancet 2000; 355:93–97.

7. Hayward AC, et al. Effectiveness of an influenza vaccine programme for care homestaff to prevent death, morbidity, and health service use among residents: clusterrandomised controlled trial. BMJ 2006. doi:10.1136/bmj.39010.581354.55.

8. Lemaitre M, et al. Effect of influenza vaccination of nursing home staff on mortality ofresidents: a cluster- randomized trial. J Am Geriatr Soc. 2009; 57: 1580–6.

9. De Serres G, et al. Influenza vaccination of healthcare workers: critical analysis ofthe evidence for patient benefit underpinning policies of enforcement. PLOS One2017; 12(1): 17-21. doi:10.1371/journal.pone.0163586 .

10. Thomas RE, et al. Influenza vaccination for healthcare workers who work with theelderly. Cochrane Database Syst Rev. 2010; 2: CD005187.

11. Seasonal influenza vaccine uptake in healthcare workers (HCWs) in England: winterseason 2018 to 2019 Public Health England. PHE publications gateway number:GW-445. May 2018. Available athttps://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/804885/Seasonal_influenza_vaccine_uptake-HCWs-2018_Final.pdf

12. Influenza Vaccination Coverage Among Health Care Personnel — United States,2017–18 Influenza Season, Morbidity and Mortality Weekly Report (MMWR) Weekly /September 28, 2018 / 67(38);1050–1054. Available athttps://www.cdc.gov/mmwr/volumes/67/wr/mm6738a2.htm?s_cid=mm6738a2_w

13. Ontario Respiratory Pathogen Bulletin Surveillance Week 13: (March 24, 2019-March30, 2019) Available at: https://www.publichealthontario.ca/-/media/documents/surveillance-reports/orpb/orpb-wk13-2018-19.pdf?la=en


27

14. New Zealand All District Health Boards 2018 DHB Health Care Worker InfluenzaImmunisation Coverage. Available at:https://www.health.govt.nz/system/files/documents/pages/2018_dhb_workforce_influenza_immunisation_vaccination_rates_final.docx

uptake of the seasonal influenza vaccine in acute ... · uptake of the seasonal influenza vaccine...

Documents